Department of Corrections and Rehabilitation - Operations Manual

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Chapter 5 – Adult Custody and Security Operations

Article 17 – Control of Dangerous and Toxic Chemicals

Revised January 26, 2015

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52030.9 Title 8, CCR, Section 3204

  • State Compensation Insurance Form (SCIFState Compensation Insurance Form) 3067 generated as a result of a hazardous substance exposure shall be stamped with red lettering in the upper right-hand corner “Hazardous Substance Exposure.” This will allow for easy identification to the SCIFState Compensation Insurance Form adjusters and their legal staff to ensure that these records shall not be destroyed.

  • Employees or their representatives requesting copies of any exposure medical records shall comply with the guidelines of Title 8, CCRCalifornia Code of Regulations, Section 3204. Employees shall first complete a CDC Form 965, Authorization for the Release of All Substance(s) Exposure and Medical Records.

  • Supervisors shall complete SCIFState Compensation Insurance Form Form 3067 to report any employee exposures to hazardous chemicals.